Candidate 40                                      Centre: Dundee
MRCOphth                                                        Date: September 2003

Clinical Cases

Glaucoma / cataract:

  • Primary open angle glaucoma. I was asked to comment on the disc and the visual field and asked if the two correlate.
  • Previous acute angle closure glaucoma. The patient had bilateral peripheral iridotomies, glaucoflecken and shallow anterior chamber.
  • Aphakia. Asked about complications and treatment.

  • Anterior segment: 

    • Floppy eyelid syndrome. Patient complains of sore, gritty eyes. I was asked to examine the patient and give possible diagnosis. I mentioned I liked to evert the eyelid and the examiner asked me to go ahead. I got to the diagnosis eventually with some prompting.
    • Bilateral corneal grafts for keratoconus. One had had previous rejection episode. Asked about the management of rejection.

    • Lattice dystrophy. Asked about the inheritance and presenting symptoms.


    • 28 year old professional footballer with low back pain and red painful eye. Asked to take a history and discuss management. Had to take his sexual history! 

    Medical examination:

    • Patient with rheumatoid arthritis. Asked to examine the hands. Had shows and socks off too and asked to comment on the feet (synovial swelling and subluxation of the joint). The patient was wearing neck collar and I was asked about atlanto-axial subluxation during operation.

    • Young man with resolving anterior uveitis. He was HLA B 27 positive with a diagnosis of ankylosing spondylitis. Discuss the management and diagnosis.

    Neuro-ophthalmology and ocular motility: 

    • Patient with myotonic dystrophy. Asked to examine the upper limb function and demonstrate the slow relaxation of the muscles after shaking.

    • Carotico-cavernous fistula. Asked to examine the patient by inspection initially. Comment on arterialization of scleral vessels. Also asked to listen for bruit. 

    • Patient with bilateral sixth nerve palsy and poor facial expression. Possibly Moebius's syndrome.

    Posterior segment: 

    • Examine with an indirect ophthalmoscope. Retinitis pigmentosa with pale disc, attenuated vessels then further examination on the slit-lamp. The patient has bilateral posterior subcapsular opacities. Asked about management of the cataract and risk of cystoid macular oedema.

    • Angioid streaks in a patient with pseudoxanthoma elasticum. The patient has choroidal neovascularization. Discuss the management of the new vessels. Laser, PDT and surgery.
    More candidates' experience